Triple Drug Combination significantly lowers LDL C in dyslipedemia patients: Study

Many patients require combination therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals. The previous study suggests that a combination of bempedoic acid with statins and/or ezetimibe significantly reduces LDL-C levels. Given their impact on LDL-C levels via different mechanisms, the combination of multiple, orally administered agents has the potential to achieve highly effective lipid-lowering; however, this has not been previously studied. Therefore, Dr John Rubino and his team conducted a study to evaluate the LDL-C lowering with the combination of bempedoic acid, ezetimibe, and atorvastatin.

It was a phase 2, randomized, double-blind, placebo-controlled study of 63 patients with hypercholesterolemia. After the washout period, researchers randomly assigned the patients to receive either triple therapy (bempedoic acid 180 mg, ezetimibe 10 mg, and atorvastatin 20 mg; n = 43) or placebo (n = 20) once daily for 6 weeks. The major outcome assessed was the per cent change from baseline in LDL-C at week 6.

Key findings of the study:

• At 6 weeks, the researchers noted that the triple therapy group had a mean LDL reduction of –63.6% compared with –3.1% among patients treated with placebo.
• They also observed a significant reduction for non–high-density lipoprotein cholesterol, total cholesterol, apolipoprotein B, and high-sensitivity C-reactive protein with triple therapy when compared with placebo.
• At 6 weeks, in the triple therapy group, they found that 90% of patients achieved LDL of less than 70 mg/dL and, 95% of patients had LDL lowered by at least 50%. However, they did not observe this achievement with a placebo.
• They noted that the majority of treatment-emergent adverse events were mild to moderate in severity with no events of elevations in aminotransferase or creatine kinase levels.

The authors concluded, " Among patients with hypercholesterolemia, the combination of bempedoic acid, ezetimibe, and atorvastatin significantly lowered LDL-C by 60.5% compared with placebo, allowing more than 90% of patients in this study to reach the recommended LDL-C <70 mg/dL goal."

For further information:

https://www.atherosclerosis-journal.com/article/S0021-9150(20)31597-5/fulltext